肝硬化食管静脉曲张破裂出血急诊治疗后早期再出血的影响因素分析

摘要

Objective To explore the influence factors of early bleeding again after emergency treatment for Liver cir-rhosis esophagus varicosity burst hemorrhage. Method 90 cases of patients with liver cirrhosis esophagus varicosity burst hemorrhage who were analyzed and accepted endoscopic treatment in our digestive internal medicine from May 2013 to May 2014 were selected.According to whether to bleed again or not in the 72 h to 6 weeks after control bleed-ing,they were divided into further hemorrhage group(28 cases) and no bleeding group (62 cases).The degree of varicose vein,Child-Pugh class of liver function,and the degree of ascites and bleeding between two groups of patients was com-pared respectively.Blood coagulation indexes (PT,PTA,PLT) and biochemical indicators (Na+,ALT,AST,TBil,Alb) between two groups of patients was analyzed respectively and the effect of various factors on the early bleeding again was ana-lyzed. Results Rebleeding group varices stage Ⅲ in 12 cases(42.86%),Child-Pugh classification of liver function grade C in 10 cases (35.71%),a large number of ascites in 15 cases (53.57%),severe bleeding,10 cases (35.71%) was signifi-cantly higher than that in non bleeding group 7 cases (11.29%),8 cases (12.90%),6 cases (9.68%),7 cases (11.29%),with statistical difference (P<0.05).Compared with no bleeding group,bleed coagulation indexes (PT,PTA,PLT) and some bio-chemical indicators(Na+,TBil,Alb) of the further hemorrhage group also existed significant difference(P<0.05).There was no significant difference in AST and ALT between two groups (P>0.05). Conclusion The degree of varicose vein,Child-Pugh class of liver function,the degree of ascites and bleeding,blood coagulation function and blood biochemical (Na+, TBil,Alb) all have an effect on early bleeding again.So it can be helpful to improve these factors to prevent early bleed-ing again of patients with liver cirrhosis esophagus varicosity burst hemorrhage.%目的：探讨肝硬化食管静脉曲张破裂出血急诊治疗后早期再出血的影响因素。方法选择本院消化内科2013年5月~2014年5月收治并给予内镜下治疗的肝硬化食管静脉曲张破裂出血患者90例，根据出血控制后72 h~6周内有无再出血分为再出血组（28例）和未出血组（62例）。比较两组患者的曲张静脉程度和肝功能Child-Pugh分级、腹水程度、出血程度，并分析两组患者的相关凝血指标（PT、PTA、PLT）和生化指标（Na+、ALT、AST、TBil、Alb），分析各因素对早期再出血的影响。结果再出血组静脉曲张Ⅲ级12例（42.86%）、肝功能Child-Pugh分级C级10例（35.71%）、大量腹水15例（53.57%）、重度出血10例（35.71%）均明显多于未出血组的7例（11.29%）、8例（12.90%）、6例（9.68%）、7例（11.29%），差异有统计学意义（P<0.05）；再出血组的凝血指标（PT、PTA、PLT）及部分生化指标（Na+、TBil、Alb）与未出血组比较，差异有统计学意义（P<0.05）；两组AST、ALT比较，差异无统计学意义（P>0.05）。结论静脉曲张程度、肝功能Child-Pugh分级、腹水程度、出血程度、凝血功能及血生化（Na+、TBil、Alb）均对早期再出血有影响，改善这些因素对预防肝硬化食管静脉曲张破裂出血患者发生早期再出血可能有一定的帮助。